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Blood Transfusion
Blood Transfusion
Introduction
Blood transfusion :
Transfer of Blood/ Blood component from donors blood to receivers circulation
Goals :
- Improve circulation volume
- Improve Hb level
- Improve coagulation mechanism
Cautions :
- Appropriate indications
- Appropriate techniques
- Observations of sign of complications
- Prevention and therapy for complications
1. Whole Blood
disadvantages :
- coagulation factors, especially factor V and VIII almost depleted ( high Hb affinity to O 2 decreased O2 release
from Hb to tissue)
- High concentration of K+, amonium and lactic acid
disadvantages :
a. possible infections hazard during preparation
b. short storing period, 4-6 hours.
3. Thrombocyt
given to patients with thrombocyt deficits due to primary disease or secondary due to bleeding.
Type of thrombocyt :
1. Platelet Rich Plasma (PRP)
PRP made by separating plasma from fresh blood
2. Platelets Concentrate
Made by centrifuging PRP and separating its thrombocyt concentrate
Storing :
a. In 40 Celcius - good haemostatic, short life span
b. In 180 Celcius - poor hemostatic, better life span
4. Plasma
a. restore blood volume and circulation
b. replace and enhance blood proteins
c. replace and improve spesific plasma factor
* Liquid plasma
made by separating plasma from whole blood on packed red cell preparation process
* Dry plasma
made by drying liquid plasma
Advantages :
- long storing time (3 years)
- easy transport
- room temperature storage
- no risk of lues infections
- independent of blood group
Disadvantages :
- higher risk of hepatitis infection due to collected from various donors.
storage :
- at temp. minus 300 C for 1 year
- at temp. minus 200 C for 6 months
ideally given on :
- bleeding cases
- as fresh whole bood replacement if mixed with packed red cell
* Cryoprecipitate
made by freezing fresh frozen plasma at minus 60 0 C and liquified at 4-6 C
advantages :
contains much amount of factor VIII and factor I (fibrinogen). A bag of cryoprecipitate contains 130 units of
Anti Hemophylic Factor (AHF)
Complications of Transfusion
1. Hemolytic Reaction
Red blood cell destructions occur producing free Hb in plasma due to blood group incompatibility. If free Hb level
more than 25 %, Hb uria occur.
Acute :
-occur immediately when transfusion.
50 cc of incompatible blood enough to precipitate the reactions
sign :
- hot sensation along the veins
- specific lumbal pain
- depressed chest feeling, dyspneu
- headache, flushing face
- raised body temp., nausea & vomitting
- during anesthesia :
tachypneu, hypotension, small pulse pressure, shock. Diffuse bleeding from operative wound.
Laboratory :
- Hb-uria
- Peripheral blood preparate hemolytic sign
- Blood bilirubine
- Free Hb in plasma
- Methemoglobine
Delayed :
Occur on patients who recieved frequent transfusion or women who previously had delivered baby.
Reactions occur after several hours or days after transfusion and commonly after transfusion of second bag or more.
Therapy :
- stop transfusion, change transfusion set
- treat shock
- shock position
- plasma expander infusion
- vasopressor
- sodium bicarbonate
- oxygenation
- asix / 20 % manitol
- corticosteroids
- report to blood bank
* send back transfused blood
* send sample of patients blood
* patients urine
- control Hb level
* thrombocyt
* fibrinogen
- give compatible fresh blood
(1). Allergy
- antigen in donors blood will bound with its antibody in recipients serum
- antibody which present in donors blood which passively transfered by transfusion to recipient
therapy :
give antihistamine and corticosteroid on severe reactions.
Therapy :
- stop transfusion
- treat shock (plasma expander, vasopressor, oxygen etc)
(4). Overload
occur due to transfusion of relatively too high volume in a short period.
For these reason, whole blood should be given cautiously on some circumstances :
- anemia
- decreased cardiac reserve
- renal disease
- oedema
sign :
- headache, precardial pain, coughing, dyspneu, heavy feeling on both arms, pulmonary rhales and elevated neck
veins
therapy :
For patients with overloading tendency :
- Infusion drips as slow as possible
(adult 12-30 drips/min, children 6-8 drips/min)
- diuretics before transfusion
- only blood component is given
- close observation during transfusion
general therapy :
- slowing transfusion rate
specific therapy:
- blood heated to body temperature
- better if switch to fresh blood
(6). Acidosis
On patients with acidosis tendency (i.e. renal failure, ileus, septic conditions) administering stored blood will worsening
those condition, so did massive transfusion.
Therapy :
-correction of acidosis with sodium bicarbonate
sign:
- ECG changes
- Cardiac arrest danger
Prevention :
- administer fresh blood
therapy :
- enforce diuresis
- Glucose 5 % infusion + regular insuline 8-12 units
Sign :
- tetany, tremor, ECG disturbances to cardiac arrest
therapy :
- Ca gluconate i.v or CaCl2 1 gram every 1000 ml of blood
Transfused
Therapy :
- administering 1 unit of FFP or cryoprecipitate for every 5 unit of whole blood.
(10). Hyperammonium
- amonium blood level increase after 5-7 days and reach maximal level after 3 weeks of storage
therapy :
- administering fresh blood.
therapy :
- positioning the patient laterally to cardiac side
- shock positioning
* Hepatitis
sign & symptoms appear 2-3 months after transfusion
sign :
icterus, hepatomegaly, spleenomegaly
therapy :
-immuniglobuline, diet to improve hepatic functions
prevention :
Donor is not accepted before 5 years of convalescence period
* Malaria
sign appear after 1-10 days afer transfusion
prevention :
Donor is not accepted under 2 years from last attack.
therapy :
- antimalarial drugs
* Syphylis
sign appear 9-10 weeks post transfusion and manifest as stage II skin lesions.
Methods for estimating blood loss
1. Measuring Gauzes Weight
Blood loss equal to gauze weight difference before and after used (1 gram equal to 1 ml blood)
2. Calori meter
Used gauze washed with standardized water and ammonium
3. Visual Estimation
Could be done by an experts. Blood clot of a fist size equal to about liter of blood.
4. Measuring blood on suction apparatus
Sometimes difficult due to other liquid mixing or suction rinsing with water.
5. Patients clinical conditions
Difficult due to anesthetic drug alter clinical response to bleeding
Transfusion techniques
4. On transfusing blood
a. Note! Blood pressure, heart rate, respiration and patinets temperature
b. Before transfusing blood, give NaCl infusion
c. If blood drips stagnant, change transfusion set
d. During first 15 minutes, patients should be carefully monitored
e. During transfusion, blood pressure & respiration must be monitored
5. Rate of transfusion
a. On massive bleeding, administer blood as fast as possible (1500 ml in 15 minutes)
b. On normovolemic patients :
adult : 500 ml / 5-6 hours
children : depend on body weight and age
6. Tricks for enhancing blood transfusion
a. Put blood bag as high as possible
b. Insert big bore catheter
c. Give pressure to blood bag
d. Injecting blood on the catheter